General Principles
E. George Elias in CRC Handbook of Surgical Oncology, 2020
Once the diagnosis of malignancy is suspected or made, several disciplines are involved in the management of such a patient. These include surgery, radiation oncology, and medical or pediatric oncology. They, in turn, depend heavily on the pathologist, the radiologist, and other medical disciplines as the case may require. There are several therapeutic modalities that can be employed in the management of cancer patients. Therefore, the American College of Surgeons has sought the establishment of a cancer program in every hospital throughout the country. One of the components of the cancer program is the tumor conference (formerly called tumor board) which consists of representatives from these various disciplines openly discussing the management of such patients. In general, surgery and radiation therapy are utilized for local and regional control of the disease, while chemotherapy, hormonal therapy, and immunotherapy are applied for systemic control. Such therapeutic approaches can be applied singularly or in combination.
Proton Therapy
Harald Paganetti in Proton Therapy Physics, 2018
The first medical application of ionizing radiation, using X-rays, was reported in 1895 [1,2]. In the following decades, radiation therapy became one of the main treatment options in oncology [3]. Many improvements have been made with respect to how radiation is administered considering biological effects, e.g., the introduction of fractionated radiation therapy in the 1920s and 1930s. In addition, technical advances have been aimed, for instance, at reducing dose to healthy tissue while maintaining prescribed doses to the target or increasing the dose to target structures with either no change or a reduction of dose to normal tissue. Computerized treatment planning, advanced imaging and patient setup, and the introduction of megavoltage X-rays are examples of new techniques that have impacted beam delivery precision during the history of radiation therapy. Another way of reducing dose to critical structures is to take advantage of dose deposition characteristics offered by different types of particles.
Treatments and Challenges
Franklyn De Silva, Jane Alcorn in The Elusive Road Towards Effective Cancer Prevention and Treatment, 2023
The proposition of exploiting the host's immune system to eliminate a disease dates back thousands of years [1185]. Although, Jenner's work in the 1700s and Coley's work in the 1800s laid down the foundation for modern immunology [1186, 1187], the understanding of the mechanisms and pathways regulating the immune system's response to chronic diseases has only expanded during the past few decades [1188]. Conventional treatment strategies such as surgery, chemotherapy, and radiotherapy have reaped substantial benefits in oncology (e.g., eradication of primary tumors [1180, 1189]), issues with disease relapse, metastases, and drug resistance, to name a few, but have precluded the ability to cure cancer [1180]. Therefore, alternative or improved treatment strategies are warranted [1180].
Comparison of case-based learning and traditional method in teaching postgraduate students of medical oncology
Published in Medical Teacher, 2019
Minghong Bi, Zhibiao Zhao, Jingru Yang, Yaping Wang
Medical oncology is a comprehensive subject, which is responsible for the difficult task of diagnosis, treatment, teaching, scientific research, and prevention. The rapid development of oncology and the relative lag of oncology teaching mode put forward higher requirements to the medical education system in the 21st century and raised a great challenge to medical educators. Medical oncology is also a highly practical subject, which greatly emphasizes the ability of clinical thinking and complex clinical problem-solving of oncology physicians. In response to the practical nature of oncology professions, oncology education should focus on clinical practice and integrate professional theories into clinical practice to improve students’ ability to solve complex clinical problems. (Schwartz et al. 2007).
The role of therapeutic drug monitoring in the management of safety of anticancer agents: a focus on 3 cytotoxics
Published in Expert Opinion on Drug Safety, 2019
Dominique Levêque, Guillaume Becker
Oncology is the first therapeutic area in terms of clinical research and development [1]. Anticancer agents represent 20–30% of the new approved entities and in the year 2018, 16 new anticancer drugs were approved in the United States (US) [2]. The recent years have been characterized by the re-birth of immunotherapies (checkpoint inhibitors that increase antitumor immunity) and the approval of cell therapies (chimeric antigen receptor or CAR-T cells) [3]. Currently, about 170 agents are available worldwide for the treatment of cancers including a hundred ‘molecularly targeted therapies’ (monoclonal antibodies, fusion proteins, enzyme or transduction inhibitors). ‘Targeted therapies’ widely differ in their pharmacokinetic profiles. Enzymes inhibitors are most given orally and are cleared by hepatic metabolism while monoclonal antibodies are administrated by intravenous or subcutaneous injection and are catabolized in endothelial cell via the FcRn receptor allowing a long terminal half-life (2–3 weeks).
Reducing ED Visits and Hospital Admissions after Chemotherapy with Predictive Modeling of Risk Factors
Published in Oncology Issues, 2021
On average, in the 10 years from 2004 to 2014, the United States has seen a 62 percent increase for commercial healthcare plans and a 73 percent increase for Medicare-associated healthcare costs.2 Oncology is unique compared to other diseases as patients often have at least two and up to five specialty areas (e.g., medical oncology, radiation oncology, surgery, cardiology) involved in their care. In 2015, the United States spent an estimated $80.2 billion on all cancer care—with 52 percent spent on hospital outpatient and clinic services and 38 percent on inpatient admissions.2 A reduction in inpatient admissions or emergency department (ED) visits would significantly improve the quality of life for patients with cancer while also reducing the cost of their care.
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